Covid-19 pandemic and decreased obstetrical emergency admissions - study at rural tertiary care center in north India

ABSTRACT

Introduction: The implementation of efforts to prevent the rapid community spread of Covid-19 slowed the spread of infection, however it also affected the routine antenatal care as well as emergency obstetric care. This study was planned to find out the number of obstetrical emergency admissions and their outcomes in the form of procedures done, maternal mortality and intrauterine dead fetus in our rural tertiary care center during Covid-19 pandemic and compare it before Covid-19 pandemic in India. Material and methods: This study was a retrospective observational study conducted over a period of 1 year (6 month during Covid-19 pandemic in India from April 2020 to September 2020 and 6 months before Covid 19 pandemic). All the patients who were admitted in the Covid-19 labour room as well as in the non Covid-19 labour room of our institute were included in the study. Ethical clearance for the study was taken from ethical committee of institute before study. Data was collected from hospital record and patients case sheets. Comparison of data before and during Covid-19 pandemic was done by using chi square test and p values analysed. Results: During the total study period of 12 months including 6 months during Covid-19 pandemic and 6 months before pandemic the total number of admissions in obstetrical emergency ward were 7630 out of which 5806 admissions (76.1%) were before Covid-19 pandemic and 1824 admissions were (23.9%) during Covid-19 pandemic and it showed significant reduction (p value <0.001) in emergency obstetrical admissions during pandemic. Out of total admissions, the number of cesareans were more during Covid-19 pandemic as compared to before it. Thus it showed significant increase in (p value < 0.001) number of caesarean deliveries during Covid-19 pandemic at our institute. Maternal mortalities were 0.89% (52 in 5754 admissions) of obstetrical emergency admissions before Covid-19 pandemic whereas it was significantly increased during Covid-19 pandemic to 2.63%. Total number of Intrauterine death and still births were 180 in 2652 vaginal deliveries (6.7%) before Covid-19 pandemic which was also increased significantly to 108 in 842 vaginal deliveries (12.8%) during 6 month of study period during Covid-19 pandemic. Conclusions: In this study we observed significant reduction in number of admissions in obstetrical emergency ward whereas significant increase in maternal mortality and intrauterine dead fetus and stillborn babies during Covid-19 pandemic. We should educate the women that delay in seeking health care can have more dangerous complications than Covid-19 infection if they will follow the Covid-19 prevention protocols. More multicentric studies should be done in India to know the effect of Covid- 19 pandemic on maternal health care services so that effect of Covid-19 pandemic can be minimized and maternal and child care can be resumed earliest as before.